How Long Until Lower Eyelid Relaxes After Canthoplasty with Enduragen Graft?

Question

26 year old male here. I am one month to the day post-op from canthoplasty/eyelid reconstruction with Enduragen Graft for mild (severe enough for me) eyelid retraction and scleral show on my lower right eyelid. Surgery was performed in LA by a very trained oculoplastic surgeon. It's been 4 weeks, yet the eyelid is still significantly overcorrected, raised very high compared to the left one and quite slanted. Is this normal?How long will it take for the lid to settle? Or, should it have by now?

A.J. Amadi, MD · Answer

Enduragen will generally take about 6 months to achieve it final result. This level of overcorrection at about a month is absolutely normal.

	Surgeons that use Enduragen routinely understand the amount of shrinkage involved and it is not guesswork. Once you have developed experience with using this product, it is actually a very nice alternative to hard palate, for patients that want to avoid the morbidity of hard palate graft.

	Though hard palate is considered the "gold standard", and I use it for the most difficult cases [re-operations, severe retraction], overall, I use hard palate and Enduragen equally, depending on the patients needs and/or preference.

	The downside of Enduragen is that in small subset of patients [in my experience it has been  5-10%], the patients have an aggressive inflammatory response, which may require removal. However, I consider it a very useful product which helps avoid a very uncomfortable/painful sore in the roof of the mouth.  In addition, not all insurance companies will pay for the cost of the product which means the patient will have to pay out of pocket.

Kenneth D. Steinsapir, MD · Answer

I personally do not like the enduragen product for this application. I still very much prefer hard palate graft. The reason for this is that hard palate graft contracts very little where as the enduragen eventually is all absorbed to be replaced with you own scar tissue. The surgeon has to do a lot of guessing to account for potential graft contraction. Hence the need for over correction. The absolute canthal angles look a bit irregular as well. TIme is very helpful here. Generally, I recommend waiting a full six months before considering revisional surgery.

Thomas A. Narsete, MD (retired) · Answer

It is hard to say how long you need to heal as I did not perform your surgeon. In my past, I waited 6-8 weeks to heal from anything I did. Based on your photos, your left lower lid appears retracted. Discuss this with your surgeon. All the best

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